The group introduced the Global Humanitarian Health Association (GHHA), a nascent professional organization for humanitarian workers. The GHHA hopes to serve as an advocacy group while developing a registry of credentialed providers and ensuring that members meet a set of yet-to-be-determined core competencies.

Hilarie Cranmer, MD, MPH, Director of Disaster Response at the Massachusetts General Hospital Center for Global Health and one of the chief architects of the new organization, stressed the need for a unified cadre of professional, consistently trained humanitarian health practitioners.

"We need to make sure that the right skill set and the right person get to the right area," she said.

The days of the "disaster cowboy" hopping on the next plane may be numbered, if GHHA can convince aid agencies and responders that a credentialing system is possible. Proper credentialing would ensure that responders understand the principles of practice in resource-poor settings and have the skills needed to function in a confusing and sometimes dangerous atmosphere. That specialized body of knowledge might not be evident by checking an applicant's medical license or board certification.

The idea of creating a vetting system and scope of practice for providers who respond to global health emergencies has gathered momentum over the past several years. Those efforts have been accelerated by the feeling among some in the disaster response community that "Haiti 2010" represented a dangerous and often embarrassing hodge-podge of inconsistency.

Cranmer alluded to that history, noting the "need to avoid the mistakes that we've made in the past with a variety of humanitarian responses." Nonetheless, she said, the new organization's role will be to "create a standard, not be a police officer."

Reaction to the proposal by NGO representatives at the workshop was guarded, although some acknowledged the need for a reliable personnel pipeline.

"We are in a human resources crisis," said Dr. Daniel Martinez Garcia, a pediatric adviser at MSF-Spain's medical department. "We have a lot of trouble finding people and a lot of trouble checking their qualifications."

One benefit of a GHHA-type system, he said, would be the ability to certify workers whose training comes from outside of the formal Western system: "Our workforce is increasingly from lower and middle income countries," Martinez explained, "and those are the people who are difficult to validate. There are very few schools of pediatrics in Africa, for example."

Canadian physician Paul Farrell, WADEM's president-elect and another member of the GHHA organizing group, is eager to shape the process with the help of the organizations he will ultimately serve: "Tell us what you need it to do," he said of the proposed registry, "and we'll build it as a one-stop shop."

"What I need is a system that allows me also to validate people that are not professional or board-certified pediatricians, but who have trained in pediatrics," said MSF's Martinez after the meeting. Such a system would go far beyond the simple online license-searches described by Farrell during the workshop.

Yet Martinez was less enthusiastic about the idea of universal skill standardization: "The skills we need are not the same in every place -- what works in Somalia doesn't work in Syria."

Brenna Adelman, RN, MSN, MSPH, a nurse from Knoxville looking to break into the field, said that she would use the system if it combined credential verification with some sort of database: "If it would allow me to apply to one place and for my services to be broadcast in a positive light, then there are benefits," Adelman said. Cost could be a concern -- NGO workers like Adelman might be more likely to cough up an annual registration fee if the data were available to a wide range of NGOs and agencies.

But the question of who ultimately has the authority to form a governing body for humanitarian response remains unsettled, especially since the proponents of the structure proposed here represent an elite slice of North American academia. Any system would need to take into account the worldwide diversity of health workers, not to mention the global nature of the population they serve.

One unintended outcome could be the creation of a two-tiered system, one of credentialed humanitarian health responders, and a second informal system of providers operating outside of the formal structure.

What does this mean for the physician who volunteers once a year with a medical mission, or the disaster "junkie" accustomed to finding their own way and helping as much as possible?

Probably nothing, until organizations like the World Health Organization and Doctors Without Borders subscribe to the idea, and smaller agencies follow suit. Host governments would have to adopt the system as well, screening responders for suitability as they cross international borders.

Until then, the ultimate responsibility may lie with humanitarian health workers themselves.

Christopher M. Tedeschi, MD, is reporting from South Africa for the WCDEM conference. He is an assistant clinical professor of emergency medicine at Columbia University Medical Center in New York City and is actively involved in teaching wilderness and environmental medicine to residents, and serves on the education committee of the Wilderness Medical Society. Tedeschi is especially focused on the applications of wilderness medicine to international medicine and disaster response and preparedness.

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